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FOR OFFICE USE: <br />- ------------------------------------------------------- <br /> .. APPLICATION FOR SANITATION PERMIT Permit No. �f <br /> ------- -- -------- -- - - --- ---- --- ---- (Co_. ate) <br /> This Permit Exprires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION--- �>L•�r�_ . ............. ._ _ ` <br /> Owner's Name. ---------._ f ---1� fi ' - ----- Phone--------------------_-•---------------------- <br /> 7 <br /> Address-----------------------7- "-7. ___ 5 <br /> Contractor's Name- -------� -I--f.`. --- -'"--------------------------------------------------------------------------------------- Phone----------------------------------- <br /> Installation will serve:v Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , <br /> Number of living units: J----- Number of bedrooms 6- Number of baths -------- Lot size ------------------------------------------------------------ <br /> Wafer Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table !.D_ ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam-b Clay Loam p Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date_ _______ __________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well __ ____Distance from foundation... d_-._--_.Material___ ' °/% c_- ,____. <br /> -------- <br /> No. of compartments.-------'--- ----------Size---�'•7t__'�= --`S-----_---Liquid depth-- q------- Capacity---� "--- <br /> Disposal Field: Distance from nearest weli..476_......Distance from foundatio ____�b..____._.Distance to nearest lot line---- <br /> Number of lines-______l__....... Length of each line-----___A1Q__ ___________Width of trent ___-_________ <br /> �i <br /> Type of filter materia '_ _.:_.. <br /> Depth of filter material-_..1 _______._..Total length...... ... ............................ <br /> .. <br /> ` i <br /> Seepage Pit: Distance to nearest well.-I&V----------Distance from To ndation__- .......... to nearest lot line...�v-_----- <br /> ❑ Number of pits-----I---------- ---Lining material_-- .. Size: Diameter__--3.1'_-----Depth.-- -------------------- <br /> Cesspool- <br /> -----_---.--.-.-._Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------ <br /> ❑ Size: Diameter- -- -------------- --------------- Depth--------------- --------------------- -------------Liquid Capacity_. <br /> Privy: Distance from nearest well------------------------------------------ --- --Distance from nearest building__.-_..--.------.-.--._-----_---..------. <br /> ❑ Distance to nearest lot line----- --------------- - - ----- ------------------------------------------------------------------------------- -------------- <br /> Remodeling and/or repairing (describe):_ 7- -....___-t.� -t�1_ ____ __ __. -1 ____ � __. FK__� <br /> ------- ---- -- ----------- ------------------------- --- ----------------- ------------ ------- ----- - --- --- --------- --------- <br /> -- - - - -------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) <br /> r (Owner and/or Contractor) <br /> -- - <br /> B <br /> t Title <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEp BY r -- = v-. =` ------------ --------------------------- DATE----�- `-�- - ----- ' --------------------- --- <br /> REVIEWEDBY------GJ 1-- --- ------------------- ----------------------------------- ------------------------------------------- DATE--------------------------------------------------------- <br /> BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- <br /> Alterations and/or recommendations:--•------- ------------------------------------------------------------------------------------------------------------------------------------------------ <br /> -------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------•------------------- <br /> ----------------- -------- --- --------- - - -•--------------------------------------- ---------------------------------------------------------------------------------------------------- --------- ----------------------- <br /> ---- ---------- ---------------- ----------------------------- ----.-------------------------------------------- -------------------------------- ------------------------------ ------ ---------------------- <br /> - <br /> A <br /> �1; <br /> FINAL INSPECTION BY:. --------- - Date---�.'_/C.-0fI ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazelton Ave. 300 We3t Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br />